Basic Information
Provider Information
NPI: 1750680484
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DENNIS
FirstName: CHRISTIAN
MiddleName: JAMES
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2121 E HARMONY RD UNIT 330
Address2:  
City: FORT COLLINS
State: CO
PostalCode: 805283403
CountryCode: US
TelephoneNumber: 9702215878
FaxNumber: 9702213564
Practice Location
Address1: 2121 E HARMONY RD UNIT 330
Address2:  
City: FORT COLLINS
State: CO
PostalCode: 805283403
CountryCode: US
TelephoneNumber: 9702215878
FaxNumber: 9702213564
Other Information
ProviderEnumerationDate: 03/21/2011
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0102XDR.0058475COY Allopathic & Osteopathic PhysiciansSurgerySurgical Critical Care

No ID Information.


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